Throughput in the Emergency Department: a Concept Analysis

The study revealed several issues in this department. Voluntary emergency patients have to wait extended periods of time before being transferred to the appropriate department. The majority of those who have to wait are those seeking mental health assistance. Keeping people in the emergency department longer than necessary cause operational costs skyrocket, and worse, keeps the needs of patients from properly being met.

When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement with unnecessary emergency room visits, a major key area is accessibility to health care at the appropriate health care setting. For many years, there has been the perception that the emergency department is the only place for someone who is uninsured or underinsured can go to receive the needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013, p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians are opting out to treating these patients, thus leading to an increase in emergency department utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and Haitsma, this is becoming a greater concern for the

14 million Canadians visit Emergency Departments (ED) every year, and also reported to having the highest use of EDs (Ontario Hospital Association, 2006). ED overcrowding in Canada has become an epidemic. ED overcrowding has been defined as “a situation in which the demand for emergency services exceeds the ability of an (emergency) department to provide quality care within acceptable time frames” (Ontario Ministry of Health and Long Term Care, 2014). This has been an ongoing problem across Canada. Ontario has developed an initiative to reduce ED wait times by implementing a variety of strategies and collaborating with other institutions. This paper describes the Emergency Room National Ambulatory Intuitive (ERNI), an

Many uninsured and underinsured focus group participants described going to emergency departments for non‐urgent care because they could not afford to pay for private care and knew they would not have to pay the emergency department charges and/or preferred to be seen as soon as possible. Several informants mentioned that the emergency department becomes a default source of primary care, which is costly and lacks the continuity of care that chronic conditions demand ("Community Health Needs Assessment,"

[20] cited (Miller, D., et. al., 2005).”“Adoption of Lean management strategies while not a simple task can help healthcare organizations improve processes and outcomes, reduce cost, and increase satisfaction among patients, providers and staff” . Balle [5] states that: “the adoption of lean in healthcare is very young it started in the late 90s but started to gain a little bit of momentum in the last decade and now in this decade many health organisations are looking at lean principles since it has been proven to be very successful in many cases around the world”.

One of the contributors to the rising cost of Healthcare can be attributed to the over use of emergency departments (EDs) for non-emergency needs. In the greater Capitol/First/Beacon Hill area there are three major hospitals (Virginia Mason, Harborview, and Swedish) with emergency rooms and no urgent care centers with the exception of Group Health which is restricted to Group Health insurance members.

Implications on Healthcare System: The general misuse of the Emergency Rooms as a replacement for patient’s primary care can be considered one reason why hospitals on Marcus Island represent the biggest hurdle with regards to healthcare cost containment. Patients are likely to use the ER for primary care because they know they will be seen on the same day at the ER, versus the potential wait time of 2-4 weeks to get an appointment to see their primary care provider. Inappropriate ER use is expensive for hospitals, and prohibits continuity of care for patients.

Lack of covered care leads the uninsured to local emergency rooms for varied health concerns. This issue will end up weakening the quality of care needed by individuals who are actually in need of emergency care because the care centers may become over populated and under staffed. In the US, there are fewer physicians per person than in most other OECD (Organization for Economic Co-operation and Development) countries. A statement in an article written on PBS’ website, states “In 2010…the U.S. had 2.4 practicing physicians per 1,000 people- well below the OECD average of 3.1.”. Facts like these are quite unsettling, considering tax dollars are still being spent on high medical costs.

With so many cases of unfilled position in the hospital patients is not obtaining great services. Patient not receiving proper cares leads to closures, because of prolonged postponements that have led to deaths. Patient complaints at the emergency room have increased in recent years. Numerous patients that were admitted to the hospital’s emergency room are at high risk of dying. Six percent of emergency rooms in the U.S. have closed. These closings took place in the inner-city and low-income areas, but with an emergency room visit increasing by nearly 51%, the overwhelming amount of closures.

NSW MINISTRY OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101 TTY. (02) 9391 9900 www.health.nsw.gov.au This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Ministry of Health. © NSW Ministry of Health 2012 SHPN (HSPI) 120204 Further copies of this document can be downloaded from the NSW Health website www.health.nsw.gov.au or Emergency Care Institute NSW website www.ecinsw.com.au August 2012

The Centers for Disease Control and Prevention (CDC, 2017) notes the following statistics pertaining to Emergency Department (ED) visits in the United States during 2013: (a) number of visits-130.4, (b) number of injury-related visits-37.2 million, (c) number of visits per 100 persons-41.9, (d) number of ED visits resulting in hospital admission 12.2 million, (e) number of ED visits resulting in admission to critical care unit-1.5 million, (f) percent of visits with patient seen in fewer than 15 minutes-29.8%, (g) percent of visits resulting in hospital admission-9.3%, and (h) percent of visits resulting in transfer to a different (psychiatric or their) hospital-2.2%.

Tang N, Stein J, Hsia RY et al: Trends and characteristics and US emergency department visits, 1997 – 2007.  JAMA 2010; 304: 664-670

Patients are using the Emergency Department for medical issues which could be better addressed by a visit to a primary care physician. A recent report

Jasmin Charles: Essay Why are the waiting times in Public hospital emergency Departments so long? What contributes to this? What are we doing too address this problem?

The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).